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Saturday, May 9, 2015

Life with an anxiety disorder - Part II: Anatomy of a panic attack

I really think one of the earliest parts of any series on my anxiety issues simply has to deal with panic attacks. There is no way around it, they are one of the definitive core issues. In this post I don't want to talk about what causes them or what underlying issues there might be triggered, and I don't want to talk about how I deal with them or how I intend to work on them therapeutically. What I want to do is to give a detailed description of what exactly happens during a panic attack, from the beginning to the end, as accurately as possible.

There's one thing everybody who experiences panic attacks knows, and that's that before everything starts, there is always some sort of early warning sign. It's different for everyone, and usually isn't related to the panic attack itself. Just something you feel that tells you there's something about to come. For me it's a tingling in my right heel. I can't explain it since I have no issue with my heel and it doesn't have anything to do with what I feel during a panic attack, but it's kind of how old people feel bad weather is about to come because their knee hurts. It's a symptom that causes no discomfort by itself, it's just a little tingling sensation, but it is also the harbinger of doom. Tingling in my right heel means bad things are about to happen. And sure enough, worse will follow like clockwork.

What comes next is one of several types of panic attacks I suffer from. I can put them into two main categories. The first is what I recently discovered to be called "somatoform autonomic dysfunction", a disorder that has you perceive physical symptoms as worse than they are and have a more serious cause than they do. Such as interpreting a stinging sensation in the chest as a heart attack. It is different from hypochondriasis in that the focus is on the symptom, not an illness. In hypochondriasis the focus is on the illness, you are convinced you have one, and any symptom is perceived as part of that. Somatoform autonomic dysfunction only occurs when the symptom is there, you overinterpret it to be more serious than it is, but once the symptom is gone you don't worry about it anymore. It is a deeply troubling experience however, because you literally believe you are about to die. Something feels off in your body and you believe it is something that will kill you. Extreme panic is this experience's natural companion.

The second main category is closer to hypochondriasis, I guess, but also sort of related to somatoform autonomic dysfunction. It is a situation in which I believe to experience a distressing physical ailment I have gone through in the past. I've had a very bad asthma attack many years ago, I believe it was an allergic reaction to aspirin. And during the time of certain panic attacks, when I feel tingling or scratching in my throat, my first thought is that I am reliving that experience, only worse. I have also almost choked to death as a toddler (according to my mother I was blue in the face and my eyes rolled back), which I don't remember consciously, but which doctors believe in ingrained in my subconscious. Which makes sense, because these types of panic attacks are associated with an intense fear of choking to death, and the conscious memory of the asthma attack is a sort of catalyst. There are different subtypes of panic attacks associated with different memories of different past experiences, such as bouts of hypoglycemia (horrible feeling), choking on vomit (happened once while I had a bad case of gastroenteritis), or that epileptic seizure I once had. They all follow the same pattern of being perceived as what's happening during the panic attack, and perceived as being lethal. Intense fear of death, intense panic.

To this point there has never been anything I could do to help alleviate the panic attack, except to repeat to myself that it is only a panic attack, that it is only in my head, and aside from that try to wait it out by distracting myself as much as I can. Certainly made me an expert on Mahjong by now. Sometimes it gets so bad I can't distract myself, I get so upset and panicky that I start pacing randomly, almost crying sometimes, almost screaming other times. There's really nothing you can do when you are at the point when you literally feel like you are living your last few seconds on Earth. Those extreme panic attacks however are rare, most of the times I can at least try to convince myself it's only a panic attack and try to distract myself. It's a horrible feeling nonetheless. This whole thing can last quite a while. Not always, sometimes it is over in a few minutes, but I've had panic attacks that lasted over an hour. Can you imagine that? It's beyond awful, over an hour of feeling you're about to kick the bucket and the intense panic associated with it.

What follows, at some point, finally, is the slow process of the panic attacks subsiding, which is sort of a rollercoaster ride all by itself. It doesn't go gradually for me, never does, rather it goes up and down, and slowly the ups decrease and the downs increase. There's a great feeling of relief during the times the symptoms lesson, and an unsettling fear of the bumps on the road when the symptoms reappear for a few moments at a time. More and more I calm down eventually, and the feeling of relief increases greatly. Made it through another one of those horrible experiences which almost feel like near death. Still alive and well. Having to deal with that type of stuff on a regular basis certainly messes up your life a lot, and among the myriads of symptoms of mental illnesses it is definitely one of the worst. Perhaps the worst, but I reserve judgement on that since there are many illnesses and symptoms I have never personally experienced. But it certainly is one messed up thing to go through.